Glossary of Terms

Glossary of Terms

835 File

  • Also referred to as: Electronic Remittance Advice (ERA)
  • The 835 is the electronic transaction that provides Claim Payment information, which is used to auto-post Claim Payments.

Aging Bucket

  • An Aging Bucket groups unpaid balances by how long they’ve been overdue to track how long Patient or Insurance Payments have been outstanding.

Allowed Fee

  • This is pulled from the uploaded Allowed Fee Schedule and indicates the Payer's expected contractual amount.

ALWD

  • This is the posted allowed amount that was provided on the EOB/ERA from the Payer for an Encounter.

AM

  • Account Manager

ANSI

  • National format standard for transmitting electronic information.

Applied Date

  • This is the date the Applied button was used on the ERA.
  • This date may be different than the Post Date since the Post Date is driven by the Date used in the Reference Batch.

Beta Feature

  • The early use of a new feature that allows Users the chance to take advantage of the functionality and provide feedback before the feature's general release.

Bill Date

  • The most recent date that the Claim was billed to the Responsible Party.

BWC

  • Bureau of Workers' Compensation (or WC)

CM

Days in A/R

  • Total A/R divided by the average billed amount per day over a given time period.
  • It is the number of days the average Claim will remain outstanding before payment is made.

DB

  • Database

Default

  • When an item is set as a default, the System will perform that action automatically the next time you access that screen or report.

Denials

  • Denials are received from a Payer after adjudication as an explanation of non-payment.

Disbursements

  • On the Receipt, the Disbursed field can be used to flag items that do not belong in the System, such as Old System Payments.

DOS

  • Date of Service

Dunning

  • Dunning is the process of businesses communicating with customers in an effort to collect money owed for goods and/or services rendered.

Dunning Level

  • Dunning Levels are a measure of where a patient's balance is in the effort to collect the balance, which drives the collection activities.
  • When a paper or e-Statement is delivered, the Dunning Level increases by 1.
  • When an acceptable payment is made, the Dunning Level decreases by 1 (or back to 0 depending on System Settings).

EDI

  • Electronic Data Interchange
  • The method in which Claims, Eligibility, and Remittances are processed electronically.

Modify Icon

  • The Pen and Paper Modify Icon appears throughout the System and is used to modify previous entries.
  • This icon will be referred to as the Modify icon in the documentation.

EFT

  • Electronic Funds Transfer
  • The Payer deposits the Payment directly into the bank instead of sending a paper check.
  • The Practice is responsible for completing the setup with each Payer.
  • We do not manage the setup for EFTs.

Encounter

  • A Charge that can contain multiple Dates of Service.
  • The System is an Encounter-based accounting system, which means it looks to the charge to drive a majority of the reporting.

EOB

  • Explanation of Benefits
  • This is a statement received from the Insurance Company that summarizes the cost of healthcare services that were rendered.
  • The EOB shows how much the Provider is charging the Insurance Company, how much the Insruance is paying, and the Patient's responsibility.
  • It is not a bill.

ERA

  • Electronic Remittance Advice
  • An electronic Explanation of Benefits (this is not the same as an EFT).
  • Some payers require enrollment to receive electronic EOBs.
  • ERAs are used to auto-apply transactions based on the file that the Payer provides.

Escrow

  • Money that has been entered into the System on a Receipt but has not yet been applied to a service/Encounter.
  • It is used as a temporary holding place until the Payment is posted in full.

Etactics

  • Clearinghouse
  • Used to send, receive, and process electronic Claims, Eligibility, and Remittances.
  • Enrollments for Claims, Eligibility, and Remittances are handled by Etactics.

Etactics Output Solutions

  • Etactics Output Solutions is a Partner that is used for sending Statements and Invoices.

Fee Schedules

  • Charge: Each DB should have one default Charge Fee Schedule. These are the fees per Procedure Code that we send on the Encounter or Charge.
  • Allowed: It is recommended that each DB has at least the Medicare Allowed Fee Schedule. This can be used to ensure that you are being paid according to the contract that you have with the Payer.

Go-Cuts

  • Keyboard shortcuts to the various areas of the System.

Go-Live

    • The date the Practice begins actively using the system for daily operations and billing activities.

      • Full Go-Live: The Practice is billing out of the system, including Electronic and Paper Claims, Invoices, and Statements.

      • Partial Go-Live: The Practice is using the System with real Patient data, such as entering Encounters or managing appointments, with the intent to begin billing.

Guarantor vs. Patient

  • The Guarantor is the person who is responsible for Payment and will receive the Statement.
  • The Patient is the person who is being seen by the Provider or getting treatment.
  • The Guarantor may be the same as the Patient or can be another person.
  • The Guarantor has an ID that can be different than the Patient ID even if the Patient is the Guarantor.
  • Example: Patient and Guarantor are the same person (Emily).
  • Emily's Patient ID is 13299
  • Emily is her own Guarantor, and her Guarantor ID is 12226.

Guarantor vs. Policy Holder

  • The Guarantor is the person who is responsible for Payment and will receive the Statement.
  • The Policy Holder/Insured is the person who carries the Insurance and is not necessarily the Guarantor.

HCFA

  • Paper Claim Form

Show Me How

  • Help documents, walk-thrus, and videos embedded in the System.

IM

  • Implementation Manager (Trainer)

Implementation

  • The process in which a Partner or a practice is involved in during the initial setup.
  • This is typically the training process.

Libraries

  • Used as the basic building blocks for Claims, Statements, and Calendar setup.

Loaded Date

  • The date the ERA was loaded into the PM System.
  • This date may be different than the Received Date.

OS

  • Output Solutions (Statement Department)

Parse

  • To convert the imported data file into System mapped fields.

Payer ID

  • Most Insurances can process Claims, Eligibility, and Remittances electronically.
  • The Payers have a correlating Payer ID which serves as an electronic address.

PM

  • Practice Management

Pop-Up

  • A smaller screen within a larger screen.
  • These may be validation errors or warnings on a screen for entering additional information.

POPS *This is a Premium Add-On Feature

  • Patient Online Payments & Schedule

Portal User / POPS Portal User

  • The Patient or Guarantor that is using the POPS Portal.

POS

  • Place of Service
  • The place where the service is performed.
  • Selecting Yes for the POS Payment field allows you to track Payments that were made in the office.
  • When adding the Receipt from the Calendar, it automatically defaults to Yes, but has to be chosen when adding a Patient Payment from other places in the System.
  • Report on POS Payments using the Custom Receipt Query, Payments & Adjustments Report, and Receipt Management Report.

Post Date

  • The Post Date is determined by the Date set in the Reference Batch.
  • It can be used to manipulate Post Dates at month end.

Receipt

  • The Receipt holds the details of the money received, who the Payer is, and how much was deposited in the bank.

Received Date

  • The Received Date is entered on the Receipt or the date that auto-populates on the ERA Receipt.
  • This is the date that the Payment was received.

Responsibility Date

  • The date that the party became responsible for the Balance.
  • Self-Pay: The date the Charge was posted.
  • Not Self-Pay: The date the Balance was transferred to the Patient.

Rejection

  • Rejections are received from the Clearinghouse or Payer before adjudication as an explanation that the Claim cannot be adjudicated as it was sent.

RTCS

  • Real-Time Claim Status
  • Electronic method of getting an immediate Claim Status update from the Payer.

RVU

  • Relative Value Unit
  • RVUs define the value of a service or procedure relative to all services and procedures.

Site Admin

  • Each practice should have 1-2 Site Admins (super Users) that will have all permissions and security rights in order to manage the database and users properly.

Statement Department

  • Etactics Output Solutions is a Partner that is used for sending Statements and Invoices.

TPA

  • A Third Party Administrator is the entity responsible for the processing and Payment of Claims for an Employer.

Visit

  • A Visit represents a distinct Date of Service in Reporting.
  • A Visit can contain multiple Encounters with the same DOS.
  • Example 1: A Patient has 4 Encounters on the same Date of Service. This is calculated as 1 Visit.
  • An Encounter can contain multiple Visits with different Dates of Service.
  • Example 2: A Patient has 1 Encounter with 4 Dates of Service. Each Date of Service counts as 1 Visit, which will be a total of 4 Visits.

WC

  • Workers' Compensation